Why blood banks are shrinking

New transfusion guidelines, surgical techniques limit need for blood

Hospitals are performing fewer blood transfusions as procedures becomes less invasive, leading to a wave of mergers and layoffs in the blood bank industry, Matthew Wald writes for the New York Times.

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Why hospitals are using less blood

Over the past five years, the number of U.S. blood transfusions has decreased by about 33%, down from 15 million units to 11 million units, according to the American Red Cross. This decline has mostly stemmed from an uptick in "minimally invasive" surgical techniques, such as laparoscopic surgery, and shifts in transfusion guidelines from different medical groups.

For instance, the Society of Thoracic Surgeons in April 2012 changed its guidelines for transfusions after coronary artery bypass grafts. Under the new regulations, a blood transfusion is not recommended until a person's hemoglobin count falls to seven grams per deciliter of blood, well under the normal count of 12 to 16 grams per deciliter. Before the new guidelines were introduced, some doctors automatically ordered a transfusion following surgery, while others did so if the patient's hemoglobin count fell below 10.

According to Wald, physicians might be adopting new transfusion guidelines faster thanks to the implementation of electronic health record systems (EHR) that are aware of the guidelines and can alert the physician if an order falls outside the norm.

Meanwhile, surgeries and cancer therapies have changed in ways that minimize the need for blood transfusions. For example, the standard loss of blood during hip replacement has dropped from 750 milliliters to about 200 milliliters.

In addition, some insurance plans discourage transfusions by paying hospitals a flat fee for the procedure regardless of how many units are dispensed. Hospitals pay between $225 and $240 per unit of blood, so big transfusions can leave hospitals and patients with big bills.

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Blood bank revenue falling

As a result of the reduction in transfusions, blood bank revenue has declined significantly and could reach $1.5 billion per year this year, down from $5 billion in 2008.

Moreover, the industry could lose 12,000 jobs within the next three to five years. According to American Red Cross EVP Christopher Hrouda, such layoffs could result in slower progress in testing and less investment in quality improvement.

Meanwhile, the industry has experience an uptick in mergers and acquisitions. Membership in America's Blood Centers—a conglomeration of independent blood banks—has fallen from 87 five years ago to 68 this year. Industry experts say that most of the blood collection agencies will remain independent, but "behind-the-scenes operations" including testing and distribution likely will merge to improve efficiency (Wald, New York Times, 8/22). 

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